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Routine: ACHS118A

ACHS118A.m

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  1. ACHS118A ;IHS/OIT/FCJ - ACHS 3.1 PATCH 18 2 of 2 ;7/30/10  08:48
  1.  ;;3.1;CONTRACT HEALTH MGMT SYSTEM;**18**;JUNE 11,2001
  1.  ;ACHS*3.1*18 New routine
  1.  ;;ACHS*3.1*18; IHS/OIT/ABK Added new tags SETBLR and LTSETS
  1.  ;
  1.  ;
  1. P16OPT ;EP - FR KIDS
  1.  ;ADD NEW OPTIONS - P16, DENIAL REPORT, 2-SSC REPORTS
  1.  D BMES^XPDUTL("Begin adding new options.")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU DEN REPORTS","ACHS DEN REP-CARE NOT MED PRI","CARE") D MES^XPDUTL($J("",5)_"Added to Denial Reports - Care not within Medical Priority")
  1.  I $$ADD^XPDMENU("ACHS MENU SCC REPORTS","ACHSRPTOBJPAY","PAY") D MES^XPDUTL($J("",5)_"Added to SSC Reports - Payment Report by Object Classification")
  1.  I $$ADD^XPDMENU("ACHS MENU SCC REPORTS","ACHSRPTOBJPAYSUM","SUM") D MES^XPDUTL($J("",5)_"Added to SSC Reports - Payment Summary Report by Object Classification")
  1.  D MES^XPDUTL("END updating options.")
  1.  Q
  1. P18OPT ;EP - FR KIDS
  1.  ;ADD NEW OPTIONS - P18, Denial GAO file, GPRA REPORT
  1.  D BMES^XPDUTL("Begin adding new options.")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN GAO","GAO",7) D MES^XPDUTL($J("",5)_"Added to Denial-Umet Need Menu - Create File for GAO")
  1.  I $$ADD^XPDMENU("ACHSREPORTS","ACHSRPT GPRA","GPRA") D MES^XPDUTL($J("",5)_"Added to Reports - GPRA Report for DOS vs Issue date")
  1.  I $$ADD^XPDMENU("ACHSMGR","ACHS CHSDA","SDA",7) D MES^XPDUTL($J("",5)_"Added to Facility Management Menu - Enter/Edit Tribal CHSDA")
  1.  I $$ADD^XPDMENU("ACHSREPORTS","ACHSRPT ELG","ELG") D MES^XPDUTL($J("",5)_"Added to Reports - CHS Eligible patients by CHSDA")
  1.  ;
  1.  ;{ABK,6/30/10} Additional options
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN MENU DENIAL","DEN",2) D MES^XPDUTL($J("",5)_"Added to ACHS Denial/Unmet Needs - Denial Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN MENU UNMET NEED","UMN",3) D MES^XPDUTL($J("",5)_"Added to ACHS Denial/Unmet Needs - Unmet Need Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN MENU PARM","PAR",1) D MES^XPDUTL($J("",5)_"Added to ACHS Denial/Unmet Needs - Unmet Need Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU PARM","ACHS DEFDEN MENU LFP","LFP") D MES^XPDUTL($J("",5)_"Added to Denial Parameters - Letter Format Parameters")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU PARM","ACHS DEFDEN MENU BENC","BC") D MES^XPDUTL($J("",5)_"Added to Denial Parameters - Benefit Coordinator Parameters")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU PARM","ACHS DEN ALT RES TYPE","ALTY") D MES^XPDUTL($J("",5)_"Added to Denial Parameters - Alternate Resource Type")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU LFP","ACHS DEFDEN MENU PARM OFF","LM") D MES^XPDUTL($J("",5)_"Added to Letter Format Parameters - Set Left Margin")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU LFP","ACHS DEFDEN MENU PARM L15","TM") D MES^XPDUTL($J("",5)_"Added to Letter Format Parameters - Set Top Margin")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU BENC","ACHS DEFDEN MENU BCN","NM") D MES^XPDUTL($J("",5)_"Added to Benefit Coordinator Parameters - Set Benefit Coordinator Name")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU BENC","ACHS DEFDEN MENU BCP","PH") D MES^XPDUTL($J("",5)_"Added to Benefit Coordinator Parameters - Set Benefit Coordinator Phone")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEFDEN MENU DEN REPORTS","REP") D MES^XPDUTL($J("",5)_"Add Denial Reports option to Denial Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEN ADD","ADD") D MES^XPDUTL($J("",5)_"Add option to Add a Denial to the Denial Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEFDEN MENU DEN LTRS","DENL") D MES^XPDUTL($J("",5)_"Add Denial Letter Menu to Denial Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEN CANCEL","CAN") D MES^XPDUTL($J("",5)_"Add Cancel option to Denial Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEFDEN MENU DEN SUPP","SUP") D MES^XPDUTL($J("",5)_"Add Denial Supplement option to ACHS Denial Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEN APPEAL MENU","APP") D MES^XPDUTL($J("",5)_"Added Appeal option to Denial Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEF ADD","ADD") D MES^XPDUTL($J("",5)_"Added Add Unmet need option to Unmet Need Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEF CANCEL","CAN") D MES^XPDUTL($J("",5)_"Added Cancel option to Unmet Need Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEF LETTER","PRT") D MES^XPDUTL($J("",5)_"Added Print Letter option to Unmet Need Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEFDEN MENU DEF SUPP","SUP") D MES^XPDUTL($J("",5)_"Added Supplemental option to Unmet Need Menu")
  1.  I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEFDEN MENU DEF RPT","REP") D MES^XPDUTL($J("",5)_"Added Report option to Unmet Need Menu")
  1.  D MES^XPDUTL("END updating options.")
  1.  ;
  1. SDA ;
  1.  D ADD^ACHSSDA
  1.  D MES^XPDUTL("Completed updating CHS Service Delivery file, for items that could not be added see ACHSTMP global")
  1.  ;
  1. SETBLR ;ACHS*3.1*18 IHS/OIT/ABK Set CHS Denial Facility Parms for denial Letter Boilerplate
  1.  N ACHSDA
  1.  ;
  1.  ;DENIAL LETTER BOILERPLATE
  1.  S MTEXT="We have been requested to authorize payment for medical services received from the above provider(s).  Please understand that after careful"
  1.  S MTEXT2=" review of the Contract Health Service rules and regulations, we must advise you the ACHSFAC will not authorize payment for the following reason(s):"
  1.  S BTEXT="RECONSIDERATION AND APPEAL [Per 42 CFR 136.25]. You may appeal the denial in writing.  Please submit a statement supporting the reason for the appeal.  NOTE: "
  1.  S BTEXT1="If you fail to submit a written appeal within (30) days of receipt of this letter, payment will be denied through the CHS program. "
  1.  S BTEXT2="If you have additional information that may affect our decision, please submit it in writing within 30 days of receipt of this letter to: "
  1.  S CTEXT="If you do not have additional information, you may appeal in writing, within 30 days of receipt of this letter:"
  1.  ;
  1.  ;SET Letter Text
  1.  S ACHSDA=0 F  S ACHSDA=$O(^ACHSDENR(ACHSDA)) Q:ACHSDA'?1N.N  D LTSETS
  1.  D DENUP
  1.  Q
  1.  ;
  1. LTSETS ; Set lettter boilerplate into facilities - quit if 638 facility
  1.  ;New variables and If unit not defined properly, quit
  1.  N ACHSX,ACHSFAC,FTIDX,EMSG
  1.  S ACHSX=$G(^ACHSF(ACHSDA,0))=""
  1.  Q:ACHSX=""
  1.  ;If Tribal quit
  1.  Q:$P(ACHSX,U,8)="Y"
  1.  ;
  1.  ;{ABK, 6/25/10}Add logic to print facility name in middle text
  1.  S ACHSFAC=$P(^DIC(4,ACHSDA,0),U,1)
  1.  ;
  1.  ;
  1.  S DIE="^ACHSDENR(",DA=ACHSDA
  1.  S DR="2///"_MTEXT_MTEXT2
  1.  S EMSG="CHS Denial Facility Parameters for Facility "_ACHSFAC_" Denial Letter Middle Text"
  1.  D ^DIE
  1.  D BMES^XPDUTL("Updated - "_EMSG)
  1.  ;
  1.  S DR="3///"_BTEXT_BTEXT1_BTEXT2
  1.  S EMSG="CHS Denial Facility Parameters for Facility "_ACHSFAC_" Denial Letter Bottom Text"
  1.  D ^DIE
  1.  D BMES^XPDUTL("Updated - "_EMSG)
  1.  ;
  1.  S DR="8///"_CTEXT
  1.  S EMSG="CHS Denial Facility Parameters for Facility "_ACHSFAC_" Denial Letter Closing Text"
  1.  D ^DIE
  1.  D BMES^XPDUTL("Updated - "_EMSG)
  1.  D ^XBFMK
  1.  Q
  1.  ;
  1. DENUP ;DENIAL REASON UPDATE FOR ALT REC
  1.  NEW ACHSDA
  1.  S X="Alternate Resource Available"
  1.  S DA=0
  1.  S DA=$O(^ACHSDENS("B",X,DA)) Q:DA'?1N.N
  1.  S DIE="^ACHSDENS("
  1.  S DA=DA,DR="1///"_""
  1.  D ^DIE
  1.  D ^XBFMK
  1.  Q
  1. ERRM ;Handle insert error messages
  1.  ;
  1.  D BMES^XPDUTL("Unable to update - "_EMSG)
  1.  D BMES^XPDUTL("You will need to manually update this text thru fileman")
  1.  D BMES^XPDUTL(X)
  1.  Q